Statement of the Problem:

There is insufficient research that addresses clinicians' perspectives over time related to the usability of an electronic medical record (EMR) system. Evaluation of human factor concepts can provide valuable insight into the development of better systems that will ultimately promote patient safety and decrease medical errors.

Specific Aims:

The aims were to explore the overall patterns of change in usability related to an EMR implementation, describe the short- and long-term change in usability, and determine whether the patterns of usability were influenced by frequency of use, sex, age, length of service, or role.

Setting and Sample:

A convenience sample of 1768 physicians, nurses, and other hospital staff in a large east coast research facility was used in this study.

Methods:

This was a retrospective longitudinal study using secondary data. Electronic survey data were collected at five different points in time over 4 years as part of a performance measurement plan. The short- and long-term impact was measured by evaluations at baseline and at 4 and 16 months after the implementation of an EMR and again following a system upgrade.

Findings:

There were significant short-term changes related to the initial EMR implementation but not to the upgrade. Age, role, length of service, and frequency of computer use were significant predictors for usefulness, ease of use, and perceived support of clinical care. Role and length of service combined were significant predictors for all short-term variables.

Discussion:

This study demonstrates that clinicians' education about system use affects their practice after system implementation. The findings consequently support early assessment and planning for system implementation, with consideration for the needs of different clinical roles. Clinicians and informatics specialists are encouraged to work together to design and implement systems that promote patient safety and improve quality of care.

Section Description

We are pleased to share the paper presentation abstracts from the Summer Institute in Nursing Informatics, Informatics at the Point of Care: A Barrier or a Bridge?, held at the University of Maryland School of Nursing, July 22 to 25, 2009. The program, chaired by Dr Judy Ozbolt, was a great success. Each of the following abstracts was selected for presentation by a peer-review committee.